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Changes in stroke volume and intrathoracic blood volume induced by a sequential leg compression in critically ill patients

Introduction

The new sequential leg compression device (SCD) (Tyco, Mansfield, MA, USA) pneumatically applies sequential compression to the lower limb, while maintaining a pressure gradient throughout the compression cycle [1, 2]. We hypothesized that the SCD Response System could shift blood volume toward the thoracic compartment comparable with a volume challenge, with an increase in preload index such as the intrathoracic blood volume index (ITBVI) and stroke volume index (SVI). The aim of the study was to evaluate the relationships between changes in SVI (ΔSVI) induced by SCD and ΔSVI induced by rapid fluid loading (RFL) in critically ill patients.

Methods

Twenty-seven patients (mean age 60 ± 9.1 years) admitted to the ICU were studied. Each patient received conventional monitoring plus hemodynamic–volumetric monitoring (PiCCO System; Pulsion Medical Systems, Munich, Germany). The heart rate, mean arterial pressure, central venous pressure, cardiac index, ITBVI, and SVI were recorded in the supine position before and after treatment with the SCD Express Compression System®. The same data where collected before and after a RFL performed with 3 ml/kg hydroxyethyl starch 6%. The relationships between ΔSVI induced by SCD and ΔSVI induced by RFL were analyzed by linear regression analysis. Statistical significance was considered to be at P < 0.05.

Results

Linear regression analysis between ΔSVI induced by SCD (ΔSCD) and ΔSVI induced by RFL (ΔRFL) showed r2 = 0.50 (P = 0.0002). When analyzed in a subgroup of spontaneously breathing versus mechanically ventilated patients, the relationships observed were respectively r2 = 0.41 (P < 0.01) (Figure 1) and r2 = 0.73 (P < 0.007) (Figure 2).

Figure 1
figure1

(abstract P309)

Figure 2
figure2

(abstract P309)

Conclusion

The SCD Response System could shift blood volume toward the thoracic compartment comparable with RFL better in mechanically ventilated than in spontaneously breathing patients. Larger population studies are needed to confirm these preliminary data.

References

  1. 1.

    Kakkos SK, et al.: Int Angiol. 2005, 24: 330-335.

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  2. 2.

    Kakkos SK, et al.: J Vasc Surg. 2005, 42: 296-303. 10.1016/j.jvs.2005.03.031

    Article  Google Scholar 

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Costa, M., Casaretti, R., Tuccillo, M. et al. Changes in stroke volume and intrathoracic blood volume induced by a sequential leg compression in critically ill patients. Crit Care 11, P309 (2007). https://doi.org/10.1186/cc5469

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Keywords

  • Blood Volume
  • Cardiac Index
  • Central Venous Pressure
  • Hydroxyethyl
  • Hydroxyethyl Starch